2c. Laryngoscope, 127:631-641, 2017.

BACKGROUND AND PURPOSE:Minimally invasive parathyroidectomy requires accurate preoperative localization of suspected adenomas, and multiphase CT allows adenoma characterization while providing detailed anatomic information. The purpose of this study was to assess the feasibility of a protocol using only arterial and venous phases to localize pathologic glands in patients with primary hyperparathyroidism.

Transoral thyroid surgery allows the surgeon to conceal incisions within the oral cavity without significantly increasing the amount of required dissection. TORT provides an ideal scarless, midline access to the thyroid gland and bilateral central neck compartments. This approach, however, presents multiple technical challenges. Herein, we present our experience using the latest generation robotic surgical system to accomplish transoral robotic thyroidectomy (TORT). In two human cadavers, the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to complete TORT. Total thyroidectomy and bilateral central neck dissection was successfully completed in both cadavers. The da Vinci Xi platform offered several technologic advantages over previous robotic generations including overhead docking, narrower arms, and improved range of motion allowing for improved execution of previously described TORT techniques.

Objective To evaluate the adherence to oral cavity quality guidelines endorsed by the American Head and Neck Society (AHNS) at a large tertiary care hospital. Methods This retrospective study identified patients treated for early‐stage oral tongue squamous cell carcinoma at a tertiary care hospital from 1992 to 2013. Patient charts were reviewed for 26 process quality measures and four key indicator process quality measures as endorsed by the AHNS. Patients were then grouped by diagnosis date either before (historical group, 1992–2007) or after (current treatment group, 2008–2013) the published process quality measures from the AHNS. Descriptive statistics were used to evaluate the rates of adherence for each process quality measure within the 2 groups. Results Of the 57 patients identified, 29 were female (51%). The mean age was 62.3 years. A majority of the oral cavity cancers were stage I (59.6%), followed by stage II (35.1%) and stage III (5.3%). Compliance with the process quality measures was in the acceptable range in both cohorts. However, several areas demonstrated lower adherence in both cohorts. Statistically significant improvements were noted between the two cohorts, which showed a measurable improvement in adherence to process quality measures in several key areas over time. Conclusion Using the process quality measures proposed by the AHNS, adherence to the process quality measures for early‐stage oral cavity cancer care at a tertiary care center was successfully evaluated. In general, good compliance with the proposed process quality measures was found and several areas for improvement were identified. Level of Evidence 2c Laryngoscope, 129:1816–1821, 2019

Miniseminars P13 MINISEMINARSProgram Description: With the progressive improvements in imaging resolution of ultrasound, concurrent reduction in capital expenditure, and portability, this modality is ideally suited to point-of-care use by most otolaryngology practices. Primary and exported training courses through the American College of Surgeons have provided a clinical starting point. An accreditation process for head and neck ultrasound is now available through a joint project between the American Institute for Ultrasound in Medicine and the Academy. This miniseminar presents the practical application of ultrasound to general, pediatric, endocrinologic, and oncologic conditions through a panel of outstanding experts from radiology and otolaryngology.Educational Objectives: (1) Cite the principles of ultrasound and its application to conditions of the head and neck. (2) Recognize the advantages of ultrasound-guided aspiration of samples for cytology and other chemical tests. (3) Learn ultrasound techniques and eventual accreditation of skills. Decision Making in the Precarious Airway Jonas T. Johnson, MD (moderator); Karen M. Kost, MD; David Goldenberg, MDProgram Description: Otolaryngologists are familiar with the available techniques for establishing an airway. In elective procedures with an anticipated difficult airway, the surgeon, anesthetist, and other members of the team may establish a clear plan of action in the controlled setting of the operating room. Upper airway obstruction may present as a life-threatening emergency in which quick action is essential and discussion time is limited. Some of these cases are extraordinarily challenging. In this miniseminar, we present the options available for establishing an airway through cases in which "standard" plans of action required modification to achieve a successful outcome.Educational Objectives: (1) Recognize what makes an airway "difficult." (2) Weigh the options available for establishing a precarious airway. (3) Establish a decision-making process through case presentations.